How to Decide Whether to Stay on Antidepressants During Your Pregnancy
If you’re pregnant or trying to become pregnant, it’s likely that your first priority is to figure out everything it takes to keep your baby healthy. From smoking and alcohol to caffeine and sushi, there’s a whole list of substances and foods that people are advised to avoid while pregnant. But while you may be able to give up your three daily iced coffees, there are some substances that may be more vital to your well-being: your antidepressants.
Effects of antidepressants on the baby
Recent research, like this 2017 study published in BMJ Open, has explored the link between antidepressant use and birth defects. More work is needed in this area, but that's easier said than done; in many cases, such studies are quite difficult to complete given the fact that they involved pregnant people and fetuses.
“It's hard to know if associations that we see in populations are caused by an antidepressant, by the underlying disease or genetics related to that disease or by coincidence,” maternal fetal medicine specialist Dr. Eva Pressman, chair of obstetrics and gynecology at the University of Rochester and board member of the Society for Maternal-Fetal Medicine, told SheKnows. “It's not possible to do a study where you randomly require people to take an antidepressant or not take an antidepressant, which is the way you figure out causation.”
Nonetheless, there are some links that you should be aware of.
Dr. Sherry A. Ross, an OB-GYN and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period., tells SheKnows, “Many antidepressants are known to cause an increase in miscarriage and birth defects early in pregnancy and fetal malformations, heart defects and reduced birth weight later in pregnancy.”
And while this may be true, Dr. Dorothy Sit, psychiatrist and associate professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine, tells SheKnows that the rates of these occurrences remains at about 3 to 5 percent for both pregnant individuals who take antidepressants and those who don’t.
Some of the more apparent effects have been observed immediately after birth. Sit explains that newborn adaptation — or neonatal withdrawal effects like jitteriness, inconsolable crying or trouble feeding — tends to be slightly more common in babies whose mothers had taken an antidepressant while pregnant. “However, these physical symptoms are time-limited and will pretty much vanish within the first three to four days,” Sit notes.
When considering long-term effects of antidepressant exposure, Sit offers more reassuring insight.
“We might detect a little bit of motor slowing and a little bit of slowing in the first 12 to 18 months after birth, but really no changes in their cognitive processes,” Sit says. “By the time we examined them during the 18- to 24-month period, the babies end up catching up.”
Risks of going off your antidepressants during pregnancy
When it comes to antidepressants, many people categorize them differently than other types of medications.
“Antidepressants are often considered a ‘luxury’ medication and are often stopped as soon as women find out they are pregnant,” Ross explains. “Mental illness[es have] common misperceptions by both patients and physicians and are not taken as seriously as other medical conditions experienced during pregnancy.”
But conditions like depression and anxiety themselves are considered to be maternal illnesses that pose dangerous risks to the developing fetus when left untreated. According to Sit, these complications can include an increased risk for preeclampsia, glucose intolerance and gestational diabetes, preterm delivery and low birth weight.
“In the most extreme case, if not being on an antidepressant would lead to suicide, that's clearly bad for the mother and bad for the developing fetus and much worse than any potential association with developmental outcomes,” Pressman adds.
For this reason, gynecologists and psychiatrists may work together to weigh the benefits of their patients taking an antidepressant versus the risks of them going off of the medication.
“It's also much more complicated to get off [medication] once you're pregnant already,” Pressman explains. “Pregnancy is a challenging time emotionally. It's a big change in your life, and the hormones affect your mood as well. Therefore, during pregnancy is not a great time to try to come off medications if you haven't tried it before.”
How to decide what option is best for you
Not all forms of depression and anxiety are the same, nor can they be treated the same. While some individuals may only need treatment for a short period of time, others who have experienced multiple episodes of depression and anxiety are at a higher risk for recurrence and may need to remain on their medications permanently. A mental health care provider can help you make this assessment.
If you do choose to stay on your antidepressants, the experts we spoke with encourage sticking to the prescription that already works for you rather than switching to something branded as more "pregnancy-friendly." While selective serotonin reuptake inhibitors are the most common during pregnancy, there is no guarantee that a specific brand will give you the response your body needs. It's best to discuss your specific needs and situation with your doctor.
Alternatively, if you wish to get off your medication, it may help to begin experimenting with a number of other treatments for depression and anxiety that do not involve medication, such as psychotherapy, support groups and even light therapy. However, do not try tapering off your dosage on your own. Instead, Sit suggests working closely with both your gynecologist and your mental health provider to gradually decrease your dosage and safely monitor your status.
“If symptoms or a cardinal sign of their depression or anxiety starts to recur, then that may actually be a signal to restart treatment and revert back to their original dose that they were taking that was helpful for them,” Sit explains.
What about the postpartum period?
When the time comes, Ross says that a pregnant person “can resume medication four weeks before the due date to help prevent the exacerbation of postpartum depression/anxiety or wait until after delivery,” depending on how each individual is coping with the change.
And if you’re planning to breastfeed, it should be noted that within medical studies of individuals treated with antidepressants, only trace amounts of the medication have been detected in their breast milk if detected at all.
“Like during pregnancy, any medication exposure to the neonate through breast milk that can be avoided should be avoided,” Pressman says. “But of course, the postpartum period is one of the most challenging times for depression and anxiety, so stopping medications in order to breastfeed is generally not recommended.”
At the end of the day, communication is key to designing the safest plan for you and your baby.
“Planning ahead is always the best defense in preventing spiralizing symptoms associated with depression and anxiety,” Ross says, advocating for a team approach among you, your gynecologist and your mental health care provider.